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Introduction: This prospective intervention study was designed to determine the efficacy of a standardized Preflight/Postflight Stretches (PPS) protocol to reduce subjective neck and back pain scores in helicopter aircrew. Aircrew transient back and neck pain is well documented, and there is currently no standardized preflight and postflight stretching protocol for Naval Aviation., Methods: Subjects were recruited from two carrier air wing MH-60R squadrons at Naval Air Station Jacksonville. These carrier air wing squadrons were selected to control for size (number of aircrew), age, and operational tempo (number of flight hours). Subjects consisted of both pilots and enlisted aircrew. One squadron was designated as the control group, although the second squadron served as the intervention group. Subjects from both groups filled out the questionnaire. Only the intervention group completed the PPS protocol immediately after completing the questionnaire and before departing the squadron spaces for the aircraft outside. Upon landing, the aircrew completed a postflight debrief. Only the intervention group completed the PPS protocol after debrief. Both the intervention and control groups once again completed the questionnaire. Questionnaires were matched by using a generated anonymous subject ID. The amounts of change and pain levels were then compared using the Mann-Whitney test and the Fisher's exact test, respectively., Results: The Kolmogorov-Smirnov test found the data to be nonparametric. The preflight and postflight overall (P ≤ .001), cervical (P ≤ .001), thoracic (P = .006), and lumbar (P = .004) differences between the control and intervention groups were found to be statistically significant when using the Mann-Whitney test. Preflight and postflight pain differences in the sacral region and "other" section were not found to be statistically significant (sacral, P = .618; others, P = .182). When evaluating the worsening of the pain level, 50 (92%) of the control flights in which PPS was not performed reported worse pain, compared to 21 (61.8%) in the intervention group where PPS was performed. The Fisher's exact test found the association between performing PPS and the worsening in pain to be statistically significant (P = .001) in the overall, cervical, thoracic, and lumbar regions. Therefore, the hypothesis was accepted in regard to overall pain, as well as in the cervical, thoracic, and lumbar regions., Conclusion: Aircrew back and neck pain because of flying is well documented. However, there is no standardized stretching protocol for aircrew to perform immediately preflight or postflight in U.S. Naval Aviation. This study demonstrated that PPS, a simple 5- to 7-min stretching routine, gives aircrew structure and can reduce postflight cervical, thoracic, lumbar, and overall pain. This phase proved to be safe as no adverse events were reported. The prehabilitation aspect could reduce conventional medical intervention, costly pharmacological management of neck and back pain, and be applied to other aviation populations in military and civilian communities., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

To understand airline transportation networks (ATN) systems we can effectively represent them as multilayer networks, where layers capture different airline companies, the nodes correspond to the airports and the edges to the routes between the airports. We focus our study on the importance of leveraging synthetic generative multilayer models to support the analysis of meaningful patterns in these routes, capturing an ATN's evolution with an emphasis on measuring its resilience to random or targeted attacks and considering deliberate locations of airports. By resorting to the European ATN and the United States ATN as exemplary references, in this work, we provide a systematic analysis of major existing synthetic generation models for ATNs, specifically ANGEL, STARGEN and BINBALL. Besides a thorough study of the topological aspects of the ATNs created by the three models, our major contribution lays on an unprecedented investigation of their spectral characteristics based on Random Matrix Theory and on their resilience analysis based on both site and bond percolation approaches. Results have shown that ANGEL outperforms STARGEN and BINBALL to better capture the complexity of real-world ATNs by featuring the unique properties of building a multiplex ATN layer by layer and of replicating layers with point-to-point structures alongside hub-spoke formations., Competing Interests: The authors have declared that no competing interests exist.

Air quality in indoor environments can have significant impacts on people's health, comfort, and productivity. Particulate matter (PM; also referred to as aerosols) is an important type of air pollutant, and exposure to outdoor PM has been associated with a variety of diseases. In addition, there is increasing recognition and concern of airborne transmission of viruses, including severe acute respiratory syndrome corona-virus 2 (SARS-CoV-2), especially in indoor environments. Despite its importance, indoor PM data during the COVID-19 pandemic are scarce. In this work, we measured and compared particle number and mass concentrations in aircraft cabins during commercial flights with various indoor environments in Atlanta, GA, during July 2020, including retail stores, grocery stores, restaurants, offices, transportation, and homes. Restaurants had the highest particle number and mass concentrations, dominated by cooking emissions, while in-flight aircraft cabins had the lowest observed concentrations out of all surveyed spaces., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: We aimed to investigate the medical characteristics of helicopter hoist operations (HHO) in HEMS missions., Methods: We designed a retrospective study evaluating all HHO and other human external cargo (HEC) missions performed by Swiss Air-Rescue (Rega) between January 1, 2010, and December 31, 2019., Results: During the study period, 9,963 (88.7 %) HEMS missions with HHO and HEC were conducted during the day, and 1,265 (11.3 %) at night. Of the victims with time-critical injuries (NACA ≥ 4), 21.1 % (n = 400) reached the hospital within 60 min during the day, and 9.1 % (n = 18) at night. Nighttime missions, a trauma diagnosis, intubation on-site, and NACA Score ≥ 4 were independently and highly significantly associated with longer mission times (p < 0.001). The greatest proportion of patients who needed hoist or HEC operations in the course of the HEMS mission during the daytime sustained moderate injuries (NACA 3, n = 3,731, 37.5 %) while practicing recreational activities (n = 5,492, 55.1 %). In daytime HHO missions, the most common medical interventions performed were insertion of a peripheral intravenous access (n = 3,857, 38.7 %) and administration of analgesia (n = 3,121, 31.3 %)., Conclusions: Nearly 20 % of patients who needed to be evacuated by a hoist were severely injured, and complex and lifesaving medical interventions were necessary before the HHO procedure. Therefore, only adequately trained and experienced medical crew members should accompany HHO missions., (© 2021. The Author(s).)

Background: Routine viral testing strategies for SARS-CoV-2 infection might facilitate safe airline travel during the COVID-19 pandemic and mitigate global spread of the virus. However, the effectiveness of these test-and-travel strategies to reduce passenger risk of SARS-CoV-2 infection and population-level transmission remains unknown., Methods: In this simulation study, we developed a microsimulation of SARS-CoV-2 transmission in a cohort of 100 000 US domestic airline travellers using publicly available data on COVID-19 clinical cases and published natural history parameters to assign individuals one of five health states of susceptible to infection, latent period, early infection, late infection, or recovered. We estimated a per-day risk of infection with SARS-CoV-2 corresponding to a daily incidence of 150 infections per 100 000 people. We assessed five testing strategies: (1) anterior nasal PCR test within 3 days of departure, (2) PCR within 3 days of departure and 5 days after arrival, (3) rapid antigen test on the day of travel (assuming 90% of the sensitivity of PCR during active infection), (4) rapid antigen test on the day of travel and PCR test 5 days after arrival, and (5) PCR test 5 days after arrival. Strategies 2 and 4 included a 5-day quarantine after arrival. The travel period was defined as 3 days before travel to 2 weeks after travel. Under each scenario, individuals who tested positive before travel were not permitted to travel. The primary study outcome was cumulative number of infectious days in the cohort over the travel period without isolation or quarantine (population-level transmission risk), and the key secondary outcome was the number of infectious people detected on the day of travel (passenger risk of infection)., Findings: We estimated that in a cohort of 100 000 airline travellers, in a scenario with no testing or screening, there would be 8357 (95% uncertainty interval 6144-12831) infectious days with 649 (505-950) actively infectious passengers on the day of travel. The pre-travel PCR test reduced the number of infectious days from 8357 to 5401 (3917-8677), a reduction of 36% (29-41) compared with the base case, and identified 569 (88% [76-92]) of 649 actively infectious travellers on the day of flight; the addition of post-travel quarantine and PCR reduced the number of infectious days to 2520 days (1849-4158), a reduction of 70% (64-75) compared with the base case. The rapid antigen test on the day of travel reduced the number of infectious days to 5674 (4126-9081), a reduction of 32% (26-38) compared with the base case, and identified 560 (86% [83-89]) actively infectious travellers; the addition of post-travel quarantine and PCR reduced the number of infectious days to 3124 (2356-495), a reduction of 63% (58-66) compared with the base case. The post-travel PCR alone reduced the number of infectious days to 4851 (3714-7679), a reduction of 42% (35-49) compared with the base case., Interpretation: Routine asymptomatic testing for SARS-CoV-2 before travel can be an effective strategy to reduce passenger risk of infection during travel, although abbreviated quarantine with post-travel testing is probably needed to reduce population-level transmission due to importation of infection when travelling from a high to low incidence setting., Funding: University of California, San Francisco., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Spatio-temporal trends in mosquito-borne diseases are driven by the locations and seasonality of larval habitat. One method of disease control is to decrease the mosquito population by modifying larval habitat, known as larval source management (LSM). In malaria control, LSM is currently considered impractical in rural areas due to perceived difficulties in identifying target areas. High resolution drone mapping is being considered as a practical solution to address this barrier. In this paper, the authors' experiences of drone-led larval habitat identification in Malawi were used to assess the feasibility of this approach., Methods: Drone mapping and larval surveys were conducted in Kasungu district, Malawi between 2018 and 2020. Water bodies and aquatic vegetation were identified in the imagery using manual methods and geographical object-based image analysis (GeoOBIA) and the performances of the classifications were compared. Further, observations were documented on the practical aspects of capturing drone imagery for informing malaria control including cost, time, computing, and skills requirements. Larval sampling sites were characterized by biotic factors visible in drone imagery and generalized linear mixed models were used to determine their association with larval presence., Results: Imagery covering an area of 8.9 km 2 across eight sites was captured. Larval habitat characteristics were successfully identified using GeoOBIA on images captured by a standard camera (median accuracy = 98%) with no notable improvement observed after incorporating data from a near-infrared sensor. This approach however required greater processing time and technical skills compared to manual identification. Larval samples captured from 326 sites confirmed that drone-captured characteristics, including aquatic vegetation presence and type, were significantly associated with larval presence., Conclusions: This study demonstrates the potential for drone-acquired imagery to support mosquito larval habitat identification in rural, malaria-endemic areas, although technical challenges were identified which may hinder the scale up of this approach. Potential solutions have however been identified, including strengthening linkages with the flourishing drone industry in countries such as Malawi. Further consultations are therefore needed between experts in the fields of drones, image analysis and vector control are needed to develop more detailed guidance on how this technology can be most effectively exploited in malaria control.

Objective: Limited information exists regarding the response of helicopter emergency medical services (HEMS) programs to patients with known or suspected coronavirus disease 2019 (COVID-19). The purpose of this study was to determine changes in flight operations during the early stages of the pandemic., Methods: A survey of the American College of Emergency Physicians Air Medical Section was conducted between May 13, 2020, and August 1, 2020. COVID-19 prevalence was defined as high versus low based on cases > 2,500 or ≤ 2,500., Results: Of the 48 respondents, the majority (89.6%) reported that their patient guidelines had changed because of COVID-19; 89.6% of programs reported transporting COVID-19-positive patients, whereas 91.5% reported transporting persons under investigation. The majority of respondents reported additional training in COVID-19 airway management (79.2%) and personal protective equipment use (93.6%). Permitted aerosol-generating procedures included bilevel positive airway pressure (40.4%) and high-flow nasal oxygen (66.0%). No difference in guideline changes, positive COVID-19/persons under investigation transport restrictions, or permitted aerosol-generating procedures were noted between high- and low-prevalence settings., Conclusion: COVID-19 has resulted in changes to HEMS guidelines regardless of local disease prevalence. The pandemic has persisted sufficiently long that data regarding the effectiveness of guideline changes should be analyzed. In the absence of definitive data, national best practices should be developed to guide COVID-19 HEMS transport., (Copyright © 2021 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

We propose an agent-based model for predicting individual flight delays in an entire air traffic network. In contrast to previous work, more detailed parameter estimation methods were incorporated into the agent-based model, acting on the state transitions of agents. Specifically, a conditional probability model was proposed for modifying the expected departure time, which was used to indicate whether a flight had experienced the necessary waiting due to Ground Delay Programs (GDPs) or carrier-related reasons. Additionally, two random forest regression models were presented for estimating the turnaround time and the elapsed time of flight agents in the agent-based delay prediction model. The parameter models were trained and fitted using the flight data for 2017 in the United States. The performance of the delay prediction model was tested for thirty days with three types of delay levels (low, medium, and high), which were randomly selected from 2018. The experimental results showed that the average absolute error in the test days was 6.8 min, and the classification accuracy with a 15 min threshold for a two-hour forecast horizon was 89.5%. The performance of our model outperformed that of existing research. Additionally, the positive effect of introducing parameter models and the negative impact of increasing the prediction horizon on the prediction performance were further studied., Competing Interests: The authors have declared that no competing interests exist.

Background: Ambulance service blood transfusion is an area of rapid development. In New South Wales, Australia, the blood products carried by ambulance medical teams are often the first available to patients with critical bleeding. In addition to the blood products routinely carried by these teams, the Service created and implemented a method of initiating large-volume, mixed-product transfusions using existing blood banks: the Retrieval Transfusion Procedure (RTP). This article describes the trends and characteristics of New South Wales Ambulance RTP activations., Materials and Methods: This retrospective database review examines the patient records for all RTP activations. Key areas of investigation include logistics, product requests, population demographics, etiologies, physiology, mission timings, and transfusions., Results: Ambulance medical teams attended 27 531 missions in the reviewed period, 1573 patients received transfusion, and there were 138 RTP activations. Blood products were sourced from 40 banks and transported by police (46.7%), ambulance (27.1%), and helicopter (13.0%) to refueling stops (39.2%), prehospital scenes (24.2%) and hospitals (15.8%). The median time engaged on each mission was 189 minutes for metropolitan and 222 minutes for rural locations. Seventy-eight patients were transfused with RTP blood products; 83.3% were traumas, of which 63.1% were motor vehicle collisions. Up to 18 units of blood products were administered before hospital arrival. There was significant (P < .001) improvement in the mean shock index of transfused patients between the first and final observations recorded., Conclusions: Ambulance service extended blood product transfusion is logistically achievable and facilitates emergency transfusions throughout the state with minimal additional infrastructure., (© 2020 AABB.)

Introduction: Helicopter transport is a resource intensive and expensive method for transportation of patients by helicopter. The primary objective of this study was to evaluate the appropriateness of helicopter transport determined by procedural care within 1-h of transfer at an urban level I trauma center., Methods: All trauma patients transported by helicopter from January 2015-December 2017 to an urban level I trauma center from referring hospitals or the scene were retrospectively analyzed. A subgroup analysis was performed evaluating patients that required a procedure or operation within 1-h of transport compared with the remainder of the patient cohort who were transported via helicopter., Results: A total of 1590 patients were transported by helicopter. Thirty-nine percent of patients (n = 612) were admitted directly to the floor from the trauma bay and 16% (n = 249) of patients required only observation or were discharged home after helicopter transfer. Approximately one-third of the entire study cohort (36%, n = 572) required any procedure, with a median time to procedure of 31.5 h (interquartile range 54.4). Only 13% (n = 74) required a procedure within 1-h of helicopter transport. The average distance (in miles) if the patient had been driven by ground transport rather than helicopter was 67.0 miles (SD ± 27.9) and would take an estimated 71.5 min (±28.4) for patients who required a procedure within 1-h compared with 61.6 miles (SD ± 30.9) with an estimated 66.1 min (SD ± 30.8) for the remainder of the cohort (P value 0.899 and 0.680, respectively)., Conclusions: This analysis demonstrates that helicopter transport was not necessary for the vast majority of trauma patients transported via helicopter., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Disorientation is one of the most important hazards in flights, but there is a need for a deeper analysis of its effect on the psychophysiological response of pilots. This study aimed to analyse the effect of disorientation training in cortical arousal, autonomic modulation, muscle strength, and perception. We analysed 39 male pilots of the Spanish Army and Air Force (27 Helicopter Pilots, 7 Transport Pilots and 5 F-18 Fighter Pilots) before and after disorientation training. Disorientation training produced an increase in perceived stress and effort in Helicopter Pilots (HP) and Transport Pilots (TP), and lower Heart Rate Variability (RMSSD) in all pilots. Rating of Perceived Exertion (RPE) and Handgrip Strength were more negatively affected among HP than in TP. RPE was more negatively affected in HP than among Fighter Pilots (FP). Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 s (FEV1) were significantly higher in FP (FVC 5.44 ± .407 l, FEV1 4.57 ± .407 l) than in HP (FVC 4.73 ± .547 l, FEV1 3.79 ± .712 l). Disorientation training affects the psychophysiological response of pilots, and different responses are depending on each job profile. These results could help to improve specific training for better preparation of pilots that face disorientation threats.

Many deceased-donor and living-donor kidney transplants (KTs) rely on commercial airlines for transport. However, the coronavirus-19 pandemic has drastically impacted the commercial airline industry. To understand potential pandemic-related disruptions in the transportation network of kidneys across the United States, we used national flight data to compare scheduled flights during the pandemic vs 1-year earlier, focusing on Organ Procurement Organization (OPO) pairs between which kidneys historically most likely traveled by direct flight (High Volume by direct Air transport OPO Pairs, HVA-OPs). Across the United States, there were 39% fewer flights in April 2020 vs April 2019. Specific to the kidney transportation network, there were 65.1% fewer flights between HVA-OPs, with considerable OPO-level variation (interquartile range [IQR] 54.7%-75.3%; range 0%-100%). This translated to a drop in median number of flights between HVA-OPs from 112 flights/wk in April 2019 to 34 in April 2020 (P < .001), and a rise in wait time between scheduled flights from 1.5 hours in April 2019 (IQR 0.76-3.3) to 4.9 hours in April 2020 (IQR 2.6-11.2; P < .001). Fewer flights and longer wait times can impact logistics as well as cold ischemia time; our findings motivate an exploration of creative approaches to KT transport as the impact of this pandemic on the airline industry evolves., (© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Speed is essential in wildlife surveys due to the dynamic movement of animals throughout their environment and potentially extreme changes in weather. In this work, we present a multirobot path-planning method for conducting aerial surveys over large areas designed to make the best use of limited flight time. Unlike current survey path-planning solutions based on geometric patterns or integer programs, we solve a series of satisfiability modulo theory instances of increasing complexity. Each instance yields a set of feasible paths at each iteration and recovers the set of shortest paths after sufficient time. We implemented our planning algorithm with a team of drones to conduct multiple photographic aerial wildlife surveys of Cape Crozier, one of the largest Adélie penguin colonies in the world containing more than 300,000 nesting pairs. Over 2 square kilometers was surveyed in about 3 hours. In contrast, previous human-piloted single-drone surveys of the same colony required over 2 days to complete. Our method reduces survey time by limiting redundant travel while also allowing for safe recall of the drones at any time during the survey. Our approach can be applied to other domains, such as wildfire surveys in high-risk weather conditions or disaster response., (Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

A multidrone path-planning algorithm enables drones to scout Adélie penguin colonies in Antarctica., (Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

Objectives: The study aimed to establish the current incidence and severity of spatial disorientation (SD) in Polish military pilots when flying different aircraft types over their entire careers, and to determine how SD training and pilots' flight experience might benefit their recognition of situations that may cause SD., Material and Methods: Overall, 176 military Polish pilots (aged 33.8±7.72 years, the number of flying hours: 1194±941) flying different aircraft types, who attended the aviation medicine course, were surveyed and asked to report their episodes of SD. To collect anonymous data, a postal SD questionnaire (INFO PUB 61/117/5) was used., Results: In the overall incidence rate of SD (96%), the most commonly experienced SD illusion was "loss of horizon due to atmospheric conditions" (81%). More SD incidents were reported by pilots who had received SD training. Some differences in the categories of the most commonly experienced SD illusion episodes between aircraft types were found. A severe episode adversely affecting flight safety was categorized by 10% of the respondents., Conclusions: In Polish military aviation, episodes of SD are a significant threat to aviation safety. There is evidence for the beneficial effects of SD training in the improvement of pilots' ability to recognize those factors that lead to SD. Int J Occup Med Environ Health. 2020;33(6):791-810., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Previous reports have suggested that breast cancer is more common among flight attendants than that in the general population. Constant exposure to cosmic radiation and circadian disruption are postulated to be the culprits of the problem. A systematic review was performed by 2 independent reviewers with predefined search strategy, in line with the PRISMA protocol. A total of 43 studies were identified using the preset keywords defined in the study protocol. After excluding irrelevant papers, 12 studies were included for pooled analysis. Ten studies evaluated the breast cancer prevalence in flight attendants, whereas 3 studies evaluated the breast cancer-related deaths. Pooled analysis found that, of the 45,111 flight attendants censored, 1061 (2.35%) had breast cancer. The standardized prevalence ratios were 1.08 (95% confidence interval [CI], 0.37-1.59) and 1.09 (95% Cl, 0.37-1.60), respectively, when compared with the American and European general population. Pooled analysis of the 3 studies on breast cancer mortality found that, of the 44,508 flight attendants censored, 139 (0.32%) had breast cancer-related mortality. Standardized mortality ratios to the American/European general population were 1.8 (95% CI, 0.63-4.25) and 1.3 (95% CI, 0.47-3.15), respectively. A review of the available literature indicates that there is insufficient evidence to suggest an association between cosmic irradiation, circadian disruption, and breast cancer in flight attendants. Breast cancer prevalence and mortality among flight attendants are comparable with that of the general population., (Copyright © 2020. Published by Elsevier Inc.)

Background: Helicopter emergency medical services (HEMS) and search and rescue helicopters (SAR) aim to bring specialized personnel to major incidents and transport patients to definite care, but their operational pattern remains poorly described. We aim to describe the use of HEMS and SAR in major incidents in Norway and investigate the feasibility of retrospectively collecting uniform data from incident reports., Methods: We searched HEMS medical databases from three HEMS and one SAR base in south-east Norway for the written reports of incidents from 2000 to 2016. After incidents were included through consensus in the author group, we collected data as described in majorincidentreporting.org and a previous cross-sectional study and rated availability of the variables., Results: From a total of 31 803 missions, we identified 50 (0.16%) major incidents with HEMS/SAR involvement where road traffic accidents were the most common type of incident (n = 28, 56%), and rural area was the most prevalent location (n = 35, 70%). Inter-agency cooperation was common and HEMS contributed most often with treatment and transport. The majority of information was found in the free-text area in the medical records hereby increasing the risk for rater variability., Conclusion: Major incidents are rare in Norway. HEMS and SAR play an important role in incident logistics, cooperation with other agencies, treatment and transport of patients and should be included in major incident plans. Retrospective data collection is challenging as data variables are not systematically integrated into the database. Future research should focus on systematic data gathering and a system for sharing lessons learned., (© 2020 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta.)

Background Time to treatment is critical for survival from sudden cardiac arrest. Every minute delay in defibrillation results in a 7% to 10% reduction in survival. This is particularly problematic in rural and remote regions, where emergency medical service response is prolonged and automated external defibrillators (AEDs) are often not available. Our primary objective was to examine the feasibility of a novel AED drone delivery method for rural and remote sudden cardiac arrest. A secondary objective was to compare response times between AED drone delivery and ambulance to mock sudden cardiac arrest resuscitations. Methods and Results We conducted 6 simulations in 2 rural communities in southern Ontario, Canada. In the first 2 simulations, the drone and ambulance were dispatched from the same paramedic base. In simulations 3 and 4, the drone and ambulance were dispatched from separate paramedic bases; and in simulations 5 and 6, the drone was dispatched from an optimized location. During each simulation, a "mock" call was placed to 911 and a single AED drone and an ambulance were simultaneously dispatched to a predetermined destination. On scene, trained first responders retrieved the AED from the drone and initiated resuscitative efforts on a mannequin until paramedics arrived. No difficulties were encountered during drone activation by dispatch, ascent, landing, or bystander retrieval of the AED from the drone. During simulations 1 and 2, the distance to the scene was 6.6 km. For simulations 3 and 4, the ambulance response distance increased to 8.8 km while drone remained at 6.6 km; and in simulations 5 and 6, the ambulance response distance was 20 km compared with 9 km for the drone. During each flight, the AED drone arrived on scene before the ambulance, between 1.8 and 8.0 minutes faster. Conclusions This study suggests AED drone delivery is feasible, with the potential for improvements in response time during simulated sudden cardiac arrest scenarios. Further research is required to determine the appropriate system configuration for AED drone delivery in an integrated emergency medical service system as well as optimal strategies to simplify bystander application of a drone-delivered AED.

Vector Disease Control International (VDCI) has a long history of aiding mosquito control efforts necessary for recovery after natural disasters like hurricanes and major floods. As waters associated with these events begin to recede, both nuisance and vector mosquito species surge in abundance and consequently play an increased role in public health. When these situations arise, state and county agencies implement emergency response plans and many rely on Federal Emergency Management Agency or private contractors for assistance in reducing mosquito populations that can alter arbovirus transmission cycles, cause intolerable stress, hamper reconstruction efforts, and disrupt normal community functions. Vector Disease Control International owns the largest fleet of fixed-wing aircraft dedicated specifically to mosquito control and has worked every major storm event since Hurricane Bonnie in 1998. This article describes the logistics and operations required for implementing VDCI's emergency management plan, including the relocation of equipment, adult mosquito surveillance, delivery of pesticides, assessment of efficacy, and filing of low-level waivers and congested-area plans with the Federal Aviation Administration., (Copyright © 2020 by The American Mosquito Control Association, Inc.)

Background: Helicopter Emergency Medical Services (HEMS) play an important role in prehospital care of the critically ill. Differences in funding, crew composition, dispatch criteria and mission profile make comparison between systems challenging. Several systems incorporate databases for quality control, performance evaluation and scientific purposes. FinnHEMS database was incorporated for such purposes following the national organization of HEMS in Finland 2012. The aims of this study are to describe information recorded in the database, data collection, and operational characteristics of Finnish HEMS during 2012-2018., Methods: All dispatches of the six Finnish HEMS units recorded in the national database from 2012 to 2018 were included in this observational registry study. Five of the units are physician staffed, and all are on call 24/7. The database follows a template for uniform reporting in physician staffed pre-hospital services, exceeding the recommended variables of relevant guidelines., Results: The study included 100,482 dispatches, resulting in 33,844 (34%) patient contacts. Variables were recorded with little or no missing data. A total of 16,045 patients (16%) were escorted by HEMS to hospital, of which 2239 (2%) by helicopter. Of encountered patients 4195 (4%) were declared deceased on scene. The number of denied or cancelled dispatches was 66,638 (66%). The majority of patients were male (21,185, 63%), and the median age was 57.7 years. The median American Society of Anesthesiologists Physical Scale classification was 2 and Eastern Cooperative Oncology Group performance class 0. The most common reason for response was trauma representing 26% (8897) of the patients, followed by out-of-hospital cardiac arrest 20% (6900), acute neurological reason excluding stroke 13% (4366) and intoxication and related psychiatric conditions 10% (3318). Blunt trauma (86%, 7653) predominated in the trauma classification., Conclusions: Gathering detailed and comprehensive data nationally on all HEMS missions is feasible. A national database provides valuable insights into where the operation of HEMS could be improved. We observed a high number of cancelled or denied missions and a low percentage of patients transported by helicopter. The medical problem of encountered patients also differs from comparable systems.

Background: Prompt prehospital triage and transportation are essential in an organised trauma system. The benefits of helicopter transportation on mortality in a physician-staffed pre-hospital trauma system remains unknown. The aim of the study was to assess the impact of helicopter transportation on mortality and prehospital triage., Methods: Data collection was based on trauma registry for all consecutive major trauma patients transported by helicopter or ground ambulance in the Northern French Alps Trauma system between 2009 and 2017. The primary endpoint was in-hospital death. We performed multivariate logistic regression to compare death between helicopter and ground ambulance., Results: Overall, 9458 major trauma patients were included. 37% (n = 3524) were transported by helicopter, and 56% (n = 5253) by ground ambulance. Prehospital time from the first call to the arrival at hospital was longer in the helicopter group compared to the ground ambulance group, respectively median time 95 [72-124] minutes and 85 [63-113] minutes (P < 0.001). Median transport time was similar between groups, 20 min [13-30] for helicopter and 21 min [14-32] for ground ambulance. Using multivariate logistic regression, helicopter was associated with reduced mortality compared to ground ambulance (adjusted OR 0.70; 95% CI, 0.53-0.92; P = 0.01) and with reduced undertriage (OR 0.69 95% CI, 0.60-0.80; P < 0.001)., Conclusion: Helicopter was associated with reduced in-hospital death and undertriage by one third. It did not decrease prehospital and transport times in a system with the same crew using both helicopter or ground ambulance. The mortality and undertriage benefits observed suggest that the helicopter is the proper mode for long-distant transport to a regional trauma centre.

BACKGROUND: Spatial disorientation, poor situational awareness, and aerodynamic stalls are often causal/contributory to general aviation accidents. To mitigate against the occurrence of these mishaps Cirrus Aircraft has, since 2002, introduced advanced avionics into their piston airplanes (Cirrus SR20/22). These airplanes are also certificated to more rigorous crashworthiness tests than legacy aircraft approved prior to these standards being codified. Herein, using for comparison two legacy aircraft fleets manufactured prior to 2002, we determined whether a reduced mishap rate for all accidents or relating to the aforementioned causes/contributing factors and/or diminished injury severity for survivable accidents were evident for Cirrus SR20/22 airplanes. METHODS: Accidents (2008-2017) involving Cirrus SR20/22 airplanes (manufactured 2002 or later) and Beechcraft 35/36 (Bonanza) and Mooney 20 models (both manufactured no later than 2001) (14CFR Part 91 rules) were identified ( N = 136, 259, 164, respectively) from the NTSB database. Statistical analyses used Poisson distribution/contingency tables/ t - and Mann-Whitney tests. RESULTS: For each year within the 2013-2017 timespan the Cirrus SR20/22 all-accident rate was diminished 39-75% relative to both legacy fleets. Temporally, the fraction of fatal Cirrus SR20/22 accidents, initially higher, declined 50% achieving a lower, or comparable, proportion to the two legacy airframes. Fatal accident rates involving spatial disorientation/situational awareness/aerodynamic stalls were > 80% lower for Cirrus SR20/22 airplanes. For survivable mishaps, Cirrus SR20/22 aircraft showed a lower proportion (0.13 compared with 0.20-0.35) of fatal/serious injuries. CONCLUSION: Toward improving legacy aircraft safety, owners should be encouraged to upgrade their avionics for mitigating against the occurrence of such human-factor-related mishaps and install airbags to minimize injury severity. Boyd DD, Howell C. Accident rates, causes, and occupant injury involving high-performance general aviation aircraft. Aerosp Med Hum Perform. 2020; 91(5):387-393.

Background: Management of pre-hospital patients remains a challenge. In developed countries a physician-staffed helicopter emergency medical service (PS-HEMS) is used in addition to ground emergency medical service (GEMS), but the effect is debated. This systematic review aimed to evaluate the effect of PS-HEMS compared with GEMS on patient outcomes based on the published scientific literature., Methods: Medline, EMBASE and the Cochrane Library were systematically searched on November 15, 2019 for prospective, interventional studies comparing outcomes of patients transported by either PS-HEMS or GEMS. Outcomes of interest were mortality, time to hospital and quality of life., Results: The majority of 18 studies included were observational and difficult to summarize because of heterogeneity. Meta-analysis could not be carried out. Three studies found reduced mortality in patients transported by PS-HEMS compared with GEMS with Odds ratios (OR) of 0.68 (0.47-0.98); 0.29 (0.10-0.82) and 0.21 (0.06-0.73) respectively. Another two studies found improved survival with OR 1.2 (1.0-1.5) and 6.9 (1.48-32.5) in patients transported by PS-HEMS compared with GEMS. In three studies, PS-HEMS was associated with shorter time to hospital. Three studies reported quality of life and found no benefit of PS-HEMS., Conclusion: In this systematic review the studies comparing PS-HEMS with GEMS were difficult to summarize because of heterogeneity. We found a possible survival benefit of PS-HEMS but were unable to conduct a meta-analysis. The overall quality of evidence was low., (© 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

The objective of this work is to advance the understanding of helicopter accidents by examining and quantifying the association between helicopter-specific configurations (number of main rotor blades, number of engines, rotor diameter, and takeoff weight) and the likelihood of accidents. We leverage a dataset of 8,338 turboshaft helicopters in the U.S. civil fleet and 825 accidents from 2005 to 2015. We use the dataset to develop a logistic regression model using the method of purposeful selection, which we exploit for inferential purposes and highlight the novel insights it reveals. For example, one important question for the design and acquisition of helicopters is whether twin-engine turboshaft helicopters exhibit a smaller likelihood of accidents than their single-engine counterparts, all else being equal. The evidence-based result we derive indicates that the answer is contingent on other covariates, and that a tipping point exists in terms of the rotor diameter beyond which the likelihood of accidents of twin-engines is higher (worse) than that of their single-engine counterparts. Another important result derived here is the association between the number of main rotor blades and likelihood of accidents. We found that for single-engine turboshaft helicopters, the four-bladed ones are associated with the lowest likelihood of accidents. We also identified a clear coupling between the number of engines and the rotor diameter in terms of likelihood of accidents. In summary, we establish important relationships between the different helicopter configurations here considered and the likelihood of accident, but these are associations, not causal in nature. The causal pathway, if it exists, may be confounded or mediated by other variables not accounted for here. The results provided here lend themselves to a rich set of interpretive possibilities, and because of their significant safety implications they deserve careful attention from the rotorcraft community., Competing Interests: The authors have declared that no competing interests exist.

Background: Military aircrews' health status is critical to their mission readiness, as they perform physically and cognitively demanding tasks in nontraditional work environments. Research Objectives: Our objective is to develop a broad operational risk assessment framework and demonstrate its applicability to health risks to aircrews because of airborne chemical exposure, considering stressors such as heat and exertion., Methods: Extrapolation of generic exposure standards to military aviation-specific conditions can include computation of risk-relevant internal dosimetry estimates by incorporating changes in breathing patterns and blood flow distribution because of aspects of the in-flight environment. We provide an example of the effects of exertion on peak blood concentrations of 1,2,4-trimethylbenzene computed using a physiologically based pharmacokinetic model., Results: Existing published collections on the effects of flight-related stressors on breathing patterns and blood flow address only a limited number of stressors. Although data exist that can be used to develop operational exposure limits specific to military aircrew activities, efforts to integrate this information in specific chemical assessments have been limited., Conclusions: Efforts to develop operational exposure limits would benefit from guidance on how to make use of existing assessments and expanded databases of the impact of environmental stressors on adult human physiology., (© Association of Military Surgeons of the United States 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Transportation of laboratory samples in low-income and middle-income countries is often constrained by poor road conditions, difficult geographical terrain, and insecurity. These constraints can lead to long turnaround times for laboratory diagnostic tests and hamper epidemic control or patient treatment efforts. Although uncrewed aircraft systems (UAS)-ie, drones-can mitigate some of these transportation constraints, their cost-effectiveness compared with land-based transportation systems is unclear., Methods: We did a comparative economic study of the costs and cost-effectiveness of UAS versus motorcycles in Liberia (west Africa) for transportation of laboratory samples under simulated routine conditions and public health emergency conditions (based on the 2013-16 west African Ebola virus disease epidemic). We modelled three UAS with operational ranges of 30 km, 65 km, and 100 km (UAS30, UAS65, and UAS100) and lifespans of 1000 to 10 000 h, and compared the costs and number of samples transported with an established motorcycle transportation programme (most commonly used by the Liberian Ministry of Health and the charity Riders for Health). Data for UAS were obtained from Skyfire (a UAS consultancy), Vayu (a UAS manufacturer), and Sandia National Laboratories (a private company with UAS research experience). Motorcycle operational data were obtained from Riders for Health. In our model, we included costs for personnel, equipment, maintenance, and training, and did univariate and probabilistic sensitivity analyses for UAS lifespans, range, and accident or failures., Findings: Under the routine scenario, the per sample transport costs were US$0·65 (95% CI 0·01-2·85) and $0·82 (0·56-5·05) for motorcycles and UAS65, respectively. Per-sample transport costs under the emergency scenario were $24·06 (95% CI 21·14-28·20) for motorcycles, $27·42 (95% CI 19·25-136·75) for an unadjusted UAS model with insufficient geographical coverage, and $34·09 (95% CI 26·70-127·40) for an adjusted UAS model with complementary motorcycles. Motorcycles were more cost-effective than short-range UAS (ie, UAS30). However, with increasing range and operational lifespans, UAS became increasingly more cost-effective., Interpretation: Given the current level of technology, purchase prices, equipment lifespans, and operational flying ranges, UAS are not a viable option for routine transport of laboratory samples in west Africa. Field studies are required to generate evidence about UAS lifespan, failure rates, and performance under different weather conditions and payloads., Funding: None., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objective: The R Adams Cowley Shock Trauma Center (STC) is Maryland's primary adult resource center for trauma care. The Shock Trauma "Go-Team" is a specialized component of Maryland's emergency medical system and is composed of a physician and certified registered nurse anesthetist. They are dispatched when advanced prehospital resuscitation is required. The purpose of this study is to describe the capabilities and historic epidemiology outcomes of the Go-Team., Methods: A retrospective case series review of recoverable Go-Team records was performed from 2011 to 2018. Go-Team call logs/records were identified from multiple sources. Medical records were reviewed for patient demographics, mechanisms of injury, and treatments in the field. There was a total of 61 activations, with 22 deployments to the scene of injury., Results: The majority of deployments were via helicopter (73%) and lasted 2 hours. The most common indications for deployment were motor vehicle entrapment (41%), trench collapse (14%), and building collapse (9%). Of the 22 patients treated by the Go-Team, 50% received at least 1 blood transfusion in the field, and 23% required an advanced airway. No field amputations were required., Conclusion: The STC Go-Team is a unique multidisciplinary specialized component of a statewide emergency medical system., (Copyright © 2019 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

The aim of this study is to calculate total cruising route effective doses using three commonly used algorithm codes CARI-6, EPCARD and SIEVERT. Further, the impact of flight cruising duration, altitude and latitude on the estimated effective doses will also be investigated. A total of 24 commercial UAE flight data were collected and retrospectively analysed. CARI-6, EPCARD and SIEVERT codes were used to estimate the total route effective doses per single trip of different destinations including USA, Europe, South Africa, Asia and Australia. Aircraft crew effective doses were shown to significantly increase with flying altitude. A strong significant correlation (0.6469; p < 0.05) was obtained between flight duration and the estimated effective doses, while a moderate insignificant correlation (0.3899; p > 0.05) was obtained with flying altitude for all 24 flights using CARI-6. For flights with the same latitude and duration, all codes gave total effective doses within experimental uncertainties., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

This survey investigates the cross-sectional association between nighttime road, rail and aircraft noise exposure and the probability to be highly sleep disturbed (%HSD), as measured by self-report in postal and online questionnaires. As part of the Swiss SiRENE study, a total of 5592 survey participants in the entire country were selected based on a stratified random sample of their dwelling. Self-reported sleep disturbance was measured using an ICBEN-style 5-point verbal scale. The survey was carried out in four waves at different times of the year. Source-specific noise exposure was calculated for several façade points for each dwelling. After adjustment for potential confounders, all three noise sources showed a statistically significant association between the nighttime noise level LNight at the most exposed façade point and the probability to report high sleep disturbance, as determined by logistic regression. The association was strongest for aircraft noise and weakest for road traffic noise. We a priori studied the role of a range of effect modifiers, including the "eventfulness" of noise exposure, expressed as the Intermittency Ratio (IR) metric, bedroom window position, bedroom orientation towards the closest street, access to a quiet side of the dwelling, degree of urbanization, sleep timing factors (bedtime and sleep duration), sleep medication intake, survey season and night air temperature. While bedroom orientation exhibited a strong moderating effect, with an Leq-equivalent of nearly 20 dB if the bedroom faces away from the nearest street, the LNight-%HSD associations were not affected by bedroom window position, sleep timing factors, survey season, or temperature., Competing Interests: The authors declare no conflicts of interest.

Background: More than 3 billion passengers are transported every year on commercial airline flights worldwide, many of whom are children. The incidence of in-flight medical events (IFMEs) affecting children is largely unknown. This study seeks to characterize pediatric IFMEs, with particular focus on in-flight injuries (IFIs)., Methods: We reviewed the records of all IFMEs from January 2009 to January 2014 involving children treated in consultation with a ground-based medical support center providing medical support to commercial airlines., Results: Among 114 222 IFMEs, we identified 12 226 (10.7%) cases involving children. In-flight medical events commonly involved gastrointestinal (35.4%), infectious (20.3%), neurological (12.2%), allergic (8.6%), and respiratory (6.3%) conditions. In addition, 400 cases (3.3%) of IFMEs involved IFIs. Subjects who sustained IFIs were younger than those involved in other medical events (3 [1-8] vs 7 [3-14] y, respectively), and lap infants were overrepresented (35.8% of IFIs vs 15.9% of other medical events). Examples of IFIs included burns, contusions, and lacerations from falls in unrestrained lap infants; fallen objects from the overhead bin; and trauma to extremities by the service cart or aisle traffic., Conclusions: Pediatric IFIs are relatively infrequent given the total passenger traffic but are not negligible. Unrestrained lap children are prone to IFIs, particularly during meal service or turbulence, but not only then. Children occupying aisle seats are vulnerable to injury from fallen objects, aisle traffic, and burns from mishandled hot items. The possible protection from using in-flight child restraints might extend beyond takeoff and landing operations or during turbulence.

Introduction: In 2011, our hospital on the Izu peninsula began to hold meetings to discuss how to manage patients with decompression illness (DCI) to establish a cooperative medical system. We retrospectively investigated the influence of these meetings and the changes subsequently effected., Methods: A medical chart review was retrospectively performed to investigate all cases between January 2005 and December 2017 in which the transport of patients with DCI via a physician-staffed helicopter emergency medical service (HEMS) was attempted. The patients were divided into 2 groups: the preprogram group and the postprogram group., Results: There were 63 patients in the preprogram group and 65 in the postprogram group. There were no cases in which a patient's symptoms deteriorated during transportation by the HEMS. The frequency of dispatch to the scene for direct evacuation in the postprogram group (86%) was greater than that in the preprogram group (74%), but the difference was not statistically significant (P=0.09). In the postprogram group, the duration of activities at the scene or the first aid hospital was significantly shorter in comparison to the preprogram group (P=0.01)., Conclusions: This retrospective study revealed simultaneity between the introduction of the yearly meetings and a reduced duration of the HEMS staff's activity at either the scene or the first aid hospital., (Copyright © 2019 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

On December 1, 2017, the Fuji factory of Arakawa Chemical Industries exploded. Dust that formed as a byproduct from the crushing and packing process of the resin for ink exploded at the facility. The Fuji City Fire Department requested the dispatch of 2 physician-staffed helicopters (known as a doctor helicopter [DH] in Japan). The first party of emergency services established a headquarters and first-aid station. However, this area was feared to be at risk of a second explosion. Physicians performed re-triage for all 11 burned patients. Three severely injured patients were transported to emergency medical service centers either by ground ambulance or the DH without undergoing any decontamination. The physician who escorted the patient by ground ambulance complained of a headache. One of the severely injured patients was treated at a local hospital and then transported to an emergency medical service center after undergoing decontamination and intubation. Fortunately, all patients who were transported to medical facilities obtained a survival outcome. Chemical, biological, radiological, nuclear, and explosive incidents are rare but can be fatal for responders to these types of disaster. Therefore, all who work in these settings should be prepared and trained adequately to ensure that they have the knowledge and skill to both manage patients and protect themselves from harm. (Disaster Med Public Health Preparedness. 2019;13:799-805).

BackgroundA variety of airline passenger data sources are used for modelling the international spread of infectious diseases. Questions exist regarding the suitability and validity of these sources.AimWe conducted a systematic review to identify the sources of airline passenger data used for these purposes and to assess validation of the data and reproducibility of the methodology.MethodsArticles matching our search criteria and describing a model of the international spread of human infectious disease, parameterised with airline passenger data, were identified. Information regarding type and source of airline passenger data used was collated and the studies' reproducibility assessed.ResultsWe identified 136 articles. The majority (n = 96) sourced data primarily used by the airline industry. Governmental data sources were used in 30 studies and data published by individual airports in four studies. Validation of passenger data was conducted in only seven studies. No study was found to be fully reproducible, although eight were partially reproducible.LimitationsBy limiting the articles to international spread, articles focussed on within-country transmission even if they used relevant data sources were excluded. Authors were not contacted to clarify their methods. Searches were limited to articles in PubMed, Web of Science and Scopus.ConclusionWe recommend greater efforts to assess validity and biases of airline passenger data used for modelling studies, particularly when model outputs are to inform national and international public health policies. We also recommend improving reporting standards and more detailed studies on biases in commercial and open-access data to assess their reproducibility.

Introduction: Mortality due to various causes, despite continuous efforts to improve the quality of medical services, is a serious problem for modern healthcare systems. Ischaemic heart disease and stroke are the cause of over 15 million deaths annually, and are therefore known as the world's number one killer., Objective: The aim of this study is to characterise the missions and the most common reasons for dispatching Helicopter Emergency Medical Service (HEMS) crews, with special emphasis on the differences between urban and rural areas., Material and Methods: The study was conducted using a retrospective analysis of HEMS missions, including flights to accidents and diseases carried out by HEMS crews in Poland from January 2014 - December 2018. The final analysis included 35,213 cases of HEMS missions., Results: The study group consisted mainly of male patients (66.40%), aged 50-64 (22.06%), mean age of the entire analysed group - 47.71 (SD: 25.96). The main reason for HEMS missions were strokes (21.63%). Analysis of patients' clinical status revealed that the clinical status of patients treated in rural areas was more severe, which was indicated by the Glasgow Coma Scale - GCS (12.03 vs 12.35) and the Revised Trauma Scale - RTS (10.14 vs 10.60) scores. When assessed by the National Advisory Committee for Aeronautics (NACA) score, body injuries and fatal diseases were observed more often in patients in rural areas (NACA 7 6.12% vs 3.46%) (p<0.05)., Conclusions: Multi-organ injuries, head traumas, sudden cardiac arrest, traumatic brain injuries, collapse and epilepsy, were more frequent reasons for HEMS missions in rural areas than in urban areas.

Introduction: Helicopter emergency medical services (HEMS) contribute to and complement other specialized search and rescue (SAR) services. Conversely, traditional SAR services perform medical evacuation (medevac), depending on crew, training, medical equipment, and procedures for interdisciplinary cooperation. We aim to describe and compare SAR and remote medevac mission characteristics in a military SAR helicopter system to a civilian HEMS operating in the same region., Methods: Retrospective, observational study of SAR and remote medevac missions performed at a Norwegian military SAR helicopter and civilian HEMS base in the 5-y period from January 1, 2013 to December 31, 2017. Descriptive statistics and median values with interquartile range (IQR) were applied where appropriate. Comparisons were performed with the Mann-Whitney U test., Results: We included 721 missions. The SAR service performed 359 (50%) missions, of which 237 (33%) were SAR and 122 (17%) were remote medevac missions. The HEMS service performed 85 (12%) SAR and 277 (38%) remote medevac missions. Median mission time for SAR missions was 152 (IQR 100-235) min for the SAR service and 57 (IQR 34-89) min for the HEMS service. Trauma was the dominating mechanism in 48% of patients, followed by medical conditions (21%) and psychiatric disorders (9%). Medevac patients in both services had a higher median National Advisory Committee for Aeronautics score of 3 (IQR 2-4) compared to 1 (IQR 0-3) in SAR missions (P<0.05)., Conclusions: Both SAR and HEMS services perform SAR and remote medevac missions extensively and mission profiles vary., (Copyright © 2019 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Civil aircraft emissions during landing and takeoff (LTO) are important air pollutant sources, but have been given insufficient attention in China. Accurate estimation of these emissions is limited by a lack of important parameters, such as detailed flight information and the dynamic time in climb and approach modes during LTO that are dependent on mixing layer height (MLH). We developed a flight-time/flight-height relationship using real-time height information in Aircraft Meteorological Data Relay data, and then calculated the actual time for each flight in those two modes based on the actual MLH from meteorological observation. Hourly emissions of civil aircraft were then estimated based on the database of each flight. Total emissions of NO x , CO, SO 2 , HC and PM from LTO cycles of domestic flights in China during 2015 were 37.78 Gg, 30.25 Gg, 12.00 Gg, 2.38 Gg and 0.75 Gg, respectively. Substantial monthly, daily and hourly variations of emissions due to the flight schedule as well as MLH were calculated. Large differences were found between the new estimation and emissions calculated based on traditional method. Compared with the emissions estimated based on default parameter obtained from International Civil Aviation Organization, the average difference of annual emission among airports with new estimation for various pollutants was approximately 30.3% in climb mode and 81.4% in approach mode; compared with the emissions estimated based on the method proposed by China National Guide, the average difference of annual emission among airports were 37.4% (NO x ), 8.4% (CO), 73.1% (HC) and 58.1% (PM) during LTO process. The monthly airport-specific emissions per LTO were also proposed. These can provide necessary and meaningful support for the revision of the values in National Guide., (Copyright © 2019. Published by Elsevier Ltd.)

Objective: Hospital-based helicopter transport programs must define and track their own lift-off times (LOTs). The goal of this quality improvement study was to evaluate LOTs, identify factors influencing LOTs, and implement changes to improve LOTs without compromising safety., Methods: A retrospective evaluation of 248 flights during 2016 was completed using recorded times from our dispatch center. Actual LOTs were compared with policy LOT goals. Tasks for flight departure were identified, timed, and sorted into those that should not be pressured and those amenable to process change., Results: Five tasks were identified as being amenable to process change. The average LOT for scene calls was 10.56 minutes (range, 1-22 minutes) and met our 10-minute policy goal 59% of the time. The average LOT for interfacility flights was 13.2 minutes (range, 4-76 minutes) and met the policy goal of 15 minutes 76.5% of the time., Conclusion: We identified tasks amenable to safe process change to decrease LOTs. The data supported LOT policy change to a single LOT goal of 13 minutes for all flights. This change represents an acceptable goal for all LOTs without compromising safety to our patients and teams., (Copyright © 2018 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

The aim of the study was to identify the characteristics of missions performed by HEMS (Helicopter Emergency Medical Service) crews and the analysis of health problems, which are the most common cause of intervention in rural areas in Poland. The study was conducted using a retrospective analysis based on the medical records of patients provided by the HEMS crew, who were present for the emergencies in rural areas in the period from January 2011 to December 2018. The final analysis included 37,085 cases of intervention by HEMS crews, which accounted for 54.91% of all the missions carried out in the study period. The majority (67.4%) of patients rescued were male, and just under a quarter of those rescued were aged between 50-64 years. Injuries (51.04%) and cardiovascular diseases (36.49%) were the main diagnoses found in the study group. Whereas injuries were significantly higher in the male group and patients below 64 years of age, cardiovascular diseases were higher in women and elderly patients ( p < 0.001). Moreover, in the group of women myocardial infarction was significantly more frequent (30.95%) than men, while in the group of men head injuries (27.10%), multiple and multi-organ injuries (25.93%), sudden cardiac arrest (14.52%), stroke (12.19%), and epilepsy (4.95%) was significantly higher. Factors that are associated with the most common health problems of rural patients are: gender and age, as well as the seasons of the year and the values of the Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and National Advisory Committee for Aeronautics (NACA) used to assess the clinical status of patients.

Purpose of Review: Helicopter air ambulances are an integral component of modern trauma care, and are able to transport patients to facilities with greater capabilities, extract injured patients from hostile terrain, and speed transport to a trauma center., Recent Findings: HAA transport does not reduce the total time required to transport a patient, but it does reduce the time that the patient is between healthcare facilities. Factors that have been suggested to improve outcomes for trauma patients include the availability of advanced interventions, skilled personnel, speed, and trauma center access. Despite their potential benefits to the patient, HAA operations carry significant risks. HAA operations are among the most dangerous professions for both pilot and crew with a mortality rate greater than commercial fishing, loggers, and steelworkers. The US Federal Aviation Administration (FAA) has identified that the four most common causes of HAA accidents as inadvertent flight into instrument meteorological conditions, loss of control, controlled flight into terrain, and night conditions., Summary: HAA operations are safe and can improve patient care, but additional research is needed to improve our understanding of HAA operations and their effect on outcomes.

Introduction: Female aviators with health conditions may face a variety of occupational impacts. Outcomes may include a waiver for continued flight or a permanent suspension, in which flight is no longer possible. The objective of this study is to determine the prevalence of medical diagnosis among female U.S. Army aviators over a ten year period and identify associations of clinical diagnoses leading to waiver or permanent suspension., Materials and Methods: This study was a secondary data analysis; data were retrieved on 1,282 female, rated aviator patients from an Army Aviation epidemiological database. The archival dataset was composed of a total of 6,856 cases between June 2005 and June 2015. Age ranged from 19 to 58 years. The data were examined in terms of raw ICD-9 diagnostic codes, grouped system diagnoses (diagnosis categories), and occupational consequence. Spearman's rho correlations were used to determine associations between diagnosis, waiver and permanent suspension., Results: The leading diagnoses were pregnancy, normal delivery, and allergic rhinitis. The systems approach yielded pregnancy, orthopedic disorders, and spinal disorders as the leading diagnosis categories. Leading waivered conditions included spinal, psychiatric, and neurological disorders. In terms of permanent suspension, the leading cause was depression, followed by migraine and post-traumatic stress disorders. In almost all diagnostic groupings, the Spearman's rho correlation coefficients between age and diagnosis were positively related. However, age was not associated with negative occupational outcome (permanent suspension), generally., Conclusions: A variety of conditions negatively impact the health and occupational status of female aviators, with disparate occupational impacts. Prevalent conditions differed from those reported previously for all aviators in a predominantly male population. The absence of cardiovascular disease is a significant change from 20-30 years ago. Among all medical diagnoses, a minority are responsible for a greater occupational burden., (Published by Oxford University Press on behalf of Association of Military Surgeons of the United States 2018.)

The objective of this work is to demonstrate a method for examining the competing effects of secular trends in body size, seat size and configuration, and the increased load factor of aeroplanes. The method uses statistical modelling and virtual fit testing to provide a flexible environment for exploring the impact of various parameters on passenger accommodation. A case study demonstrates the method by exploring the effect of seat width on the accommodation of US civilians (based on seated hip breadth). The case study demonstrates that recent trends of decreasing seat widths and increasing load factors lead to higher disaccommodation. Based on anthropometry and virtual fit, women are also shown to be disproportionately disaccommodated compared to men. Practitioner summary: Airlines are reducing seat width at the same time that individuals worldwide are getting larger. Flights are increasingly crowded, with load factor at a record high. This paper explores the effects of seat width on passenger accommodation under several scenarios involving load factor, demographics, and passenger seating allocation strategies.

Objectives: Fly-in, fly-out (FIFO) work involves long commutes, living on-site for consecutive days and returning home between shifts. This unique type of work requires constant transitioning between the roles and routines of on-shift versus off-shift days. This study aims to examine health behaviour patterns of FIFO workers and FIFO partners during on-shift and off-shift time frames., Design: This study used ecological momentary assessment and multilevel modelling to examine daily health behaviours., Setting: FIFO workers and FIFO partners from across Australia responded to daily online surveys for up to 7 days of on-shift and up to 7 days of off-shift time frames., Participants: Participants included 64 FIFO workers and 42 FIFO worker partners., Results: Workers and partners reported poorer sleep and nutrition quality for on-shift compared with off-shift days. Both workers and partners exercised less, smoked more cigarettes, took more physical health medication and drank less alcohol during on-shift compared with off-shift days., Conclusions: FIFO organisations should consider infrastructure changes and support services to enhance opportunities for quality sleep and nutrition, sufficient exercise, moderate alcohol consumption and cigarette cessation for workers on-site and their partners at home., Competing Interests: Competing interests: The not-for-profit organisation LIVIN Australia donated incentives for participants in the study, but had no influence on the study procedures, data collection, analyses or dissemination. ALR receives funding from the National Health and Medical Research Council of Australia. CV receives funding from the National Heart Foundation of Australia., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Rapid transfer of trauma patients to a trauma center for definitive management is essential to increase survival. The utilization of helicopter transportation for this purpose remains heavily debated. The purpose of this study was to characterize the trends in helicopter transportations of trauma patients in the United States over the last decade. Subjects with a primary mode of either ground or helicopter transportation were selected from the National Trauma Data Bank datasets 2007 to 2015. Over this period, the proportion of patients transported by a helicopter decreased significantly in a linear fashion from 17 per cent in 2007 to 10.2 per cent in 2015 ( P < 0.001). The overall mortality of this population was 7.6 per cent and remained unchanged over the study period ( P = 0.545). Almost 3 of 10 subjects (29.4%) transported by a helicopter had an Injury Severity Score <9. The proportion of elderly (>65 years) patients requiring helicopter transportation increased by 69.1 per cent, whereas their associated mortality decreased by 21.5 per cent. The use of a helicopter for the transportation of trauma patients has significantly decreased over the last decade without any significant change in mortality, possibly indicating more effective utilization of available resources. Overtriage of patients with minor injuries remained relatively unchanged.

Beijing Capital International Airport (ZBAA) is the world's second busiest airport. In this study, the emissions of air pollutants from aircraft and other sources at ZBAA in 2015 were estimated using an improved method, which considered the mixing layer height calculated based on aircraft meteorological data relay (AMDAR), instead of using the height (915m) recommended by ICAO. The yearly emissions of NO x , CO, VOCs, SO 2 , and PM 2.5 at the airport were 8.76×10 3 , 4.43×10 3 , 5.43×10 2 , 4.80×10 2 , and 1.49×10 2 ton/year, respectively. The spatial-temporal distribution of aircraft emissions was systematically analyzed to understand the emission characteristics of aircraft. The results indicated that NO x was mainly emitted during the take-off and climb phases, accounting for 20.5% and 55.5% of the total emissions. CO and HC were mainly emitted during the taxi phase, accounting for 91.6% and 92.2% of the total emissions. Because the mixing layer height was high in summer, the emissions of aircraft were at the highest level throughout the year. Based on the detailed emissions inventory, four seasons simulation using WRF-CMAQ model was performed over the domain surrounding the airport. The results indicated that the contribution to PM 2.5 was relatively high in winter; the average impact was about 1.15μg/m 3 within a radius of 1km around the airport. Meanwhile, the near surroundings and southwest areas of the airport are the most sensitive to PM 2.5., (Copyright © 2018. Published by Elsevier B.V.)

In 2014, the United States Federal Aviation Administration chose six sites at which to conduct research crucial to integrating unmanned aircraft systems into the nation's airspace. Analyzing data collected from five focus groups that we conducted at one of these test sites, this article centers on the gendered and racialized politics of civilian unmanned aircraft. Civilian drone use remains a relatively unchallenged space for displaying hypermasculinity via technological expertise. Focusing on the topic of surveillance, we argue that a very particular, intersectional perspective - white technomasculinity - profoundly influences how civilian unmanned aircraft are imagined, designed and deployed. While this perspective went unmarked and was taken for granted by most of our focus group participants, our analysis highlights the constructed and contingent nature of white technomasculinity, and we argue that a critical technological consciousness is necessary to prevent these technologies from reinforcing or exacerbating unequal distributions of rights and responsibilities among differently located social actors. We conclude our paper on a cautiously hopeful note, drawing attention to moments in which more distributed, or 'sousveillant', uses of civilian UAS appeared possible.

Aim: To examine the stroke risks associated with aircraft, road traffic, and railway noise exposure in a large case-control study., Materials and Methods: All people aged ≥40 years living around the Frankfurt airport that were insured by one of three large statutory health insurance funds between 2005 and 2010 were included in the study (n = 1,026,670). Address-specific exposure to aircraft, road, and railway traffic noise was estimated for 2005. We used insurance claim data to identify 25,495 newly diagnosed cases of stroke between 2006 and 2010 and compared them with 827,601 control participants. Logistic regression analysis was used to calculate the odds ratios adjusted for age, sex, local proportion of people receiving unemployment benefits, and if available individual indicators of socioeconomic status (education, occupation)., Results: For 24-h continuous aircraft noise exposure, neither increased risk estimates nor a positive linear exposure-risk relation was found. However, stroke risk was statistically significantly increased by 7% [95% confidence intervals (95%CI): 2-13%] for people who were exposed to <40 dB of 24-h continuous aircraft noise, but ≥6 events of maximum nightly sound pressure levels ≥50 dB. For road and railway traffic noise, there was a positive linear exposure-risk relation: Per 10 dB the stroke risk increased by 1.7% (95%CI: 0.3-3.2%) for road traffic noise and by 1.8% (95%CI: 0.1-3.3%) for railway traffic noise. The maximum risk increase of 7% (95%CI: 0-14%) for road traffic noise and 18% (95%CI: 2-38%) for railway traffic noise was found in the exposure category ≥65 to <70 dB., Conclusion: This large case-control study indicates that traffic noise exposure may lead to an increase in stroke risk. It furthermore suggests that maximum aircraft noise levels at night increase the stroke risk even when continuous noise exposure is low, and thus highlights the relevance of maximum noise levels for research and policies on noise protection., Competing Interests: There are no conflicts of interest